The effect of non-surgical and surgical mechanical root debridement on infrabony defects: a retrospective study

The aim of this retrospective study was to assess the outcomes of non-surgical and surgical mechanical root debridement for the treatment of infrabony defects and explore potential prognostic factors. Treated infrabony defects followed for at least 1 year were selected. All data pertaining to the clinical outcomes were recorded. Multi-level regression analysis and Cox Proportional-Hazards Models were used to assess the immediate (3–6 months) clinical outcomes, survival of the treated teeth, and factors influencing these results. 132 patients were included in the analysis. The analysis showed 1.42 ± 1.71 and 2.23 ± 1.64 mm in pocket depth (PD) reduction, 0.13 ± 1.83 and 0.08 ± 1.76 mm in clinical attachment level (CAL) gain, and 1.29 ± 1.56 and 2.15 ± 1.33 mm increase in gingival recession (REC) for the non-surgical and surgical groups, respectively. The 5-year survival rates were 93% for the non-surgically and 90% for the surgically treated teeth. Several factors affected clinical outcomes and tooth survival. Within its limitations, the treatment of infrabony defects with non-surgical and surgical mechanical root debridement was found to result in moderate but significant PD reduction, nevertheless, this may also be attributable to the resultant REC.

Comparison of Biocompatibility of Experimental Tricalcium Phosphate Cement versus Biodentin and Mineral Trioxide Aggregate used for Furcation Perforation Repair (in vivo study)

Background: The interaction between the root canal system and the oral cavity caused by iatrogenic perforations significantly affects the treatment outcome and tooth survival. Objectives: This study was directed to compare the biocompatibility of an experimental tricalcium phosphate cement versus biodentine and mineral Trioxide aggregate used for furcation perforation repair in dogs. Methods: Perforations were done in 60 teeth (premolars and molars) of six adult dogs. Animals were divided randomly into 3 equal groups of 2 animals each according to the post-operative evaluation period of 1 week, 1 month, and 3-months. Each group was further subdivided into 4 subgroups according to either being repaired with the experimental tricalcium phosphate cement (n=6), or Biodentine (n=6), Mineral Trioxide Aggregate (MTA) (n=6), and positive control(n=2). After evaluation periods, tissue blocks were harvested and histologically examined. Results: No statistically significant difference was found regarding bone deposition scores and inflammatory reaction in the three groups after 1 week, 1 month, or 3 months. All three groups showed a statistically significant difference between all three time periods. Regardless of the repair material used, inflammation scores at 1-week showed the highest scores, decreasing over time except for the control group. Conclusion: The experimental material could be considered as a successful treatment option for repairing furcation perforation.

Impact of non-restorative cavity control on proximal carious lesions of anterior primary teeth on the tooth survival and patient-centered outcomes (CEPECO 2): study protocol for a non-inferiority randomized clinical trial

Background Studies have questioned the necessity of restoring cavitated carious lesion on primary teeth, once the control of biofilm is the most important factor to arrest these lesions. This randomized clinical trial aimed to compare the survival of teeth treated with a non-restorative cavity control (NRCC) compared to resin composite restorations (RCR) on proximal carious lesion in anterior primary teeth, as well as the impact of these treatments on patient-centered outcomes. Methods A randomized clinical trial with two parallels arms (1:1) will be conducted. Children between 3 and 6 years old will be selected from the Center of Clinic Research of Pediatric Dentistry of Ibirapuera University (UNIB), a dental trailer (FOUSP) located on Educational Complex Professor Carlos Osmarinho de Lima, the Pediatric Dentistry Clinic of Santa Cecília University and from the Pediatric Dentistry Clinic of University Center UNINOVAFAPI. One hundred and forty-eight teeth will be randomly distributed in two experimental groups: (1) Selective removal of carious tissue and RCR; or (2) NRCC through cavity enlargement using a metallic sandpaper. The primary outcome will be tooth survival after 6, 12, 18 and 24 months. The duration and the cost of dental treatments will be considered for the estimation of the cost-effectiveness of the evaluated treatments. The discomfort reported by the participants will be measured after each treatment using the FIS scale. The participants’ satisfaction and perception of the parents/legal guardians will be evaluated through questionnaires. For the primary outcome, Kaplan–Meier’s survival and Long-Rank test will be used for comparison between the two groups. All the variables will be modeled by Cox regression with shared fragility. Significance will be considered at 5%. Discussion The NRCC could be an option to manage carious lesions on proximal surfaces of primary teeth, and the approach could be well accepted by the children and parents/legal guardians. Trial registration Clinicaltrials.gov registration: NCT03785730, Registered on December 18th 2018, first participant recruited 30/04/2019, https://clinicaltrials.gov/ct2/show/NCT03785730. Ethics Reference No: 91569118.8.0000.5597. Trial Sponsor: Universidade Ibirapuera. The Trial was prospectively registered.

Long-Term Follow-Up of Nonsurgical Endodontic Treatments Performed by One Specialist: A Retrospective Cohort Study about Tooth Survival and Treatment Success

Background. The main aim of the retrospective cohort study was to evaluate tooth survival after the endodontic treatment over a period of more than 20 years. Moreover, success of the treatment and the correlation between baseline parameters and the outcomes were analyzed, and causes were recorded. Materials and Methods. Clinical records (including radiographs) of subjects treated with endodontic procedures (both primary and secondary (nonsurgical retreatment)) were collected and analyzed, covering a period of up to 29 years. Type of the treatment, technique, adequacy of treatment performed, presence of baseline radiolucency, and symptoms at baseline were recorded. Moreover, failure (presence of radiolucency 2 years after treatment) and tooth extraction data and causes of them were recorded. Outcomes were explored by using survival analysis (Kaplan–Meier estimates and survival table analysis) and regression analysis (Cox regression). Results. A total of 2,679 endodontically treated teeth were included in the analysis. After 20 years from the treatment, the cumulative survival rate for primary and secondary treatments was 84.10% (80.99%–87.21%) and 89.79% (86.68%–92.90%), respectively. No differences were found between primary and secondary treatments or with regard to the technique adopted. The presence of periapical radiolucency was correlated to higher odds of tooth extraction. Conclusions. Despite the limitations of the study, we can assume that the proportion of retained endodontically treated teeth was significantly high over a long-term period.

Development of an Organic–Inorganic Nanostructured Hybrid Dental Biocomposite

Dental pathologies such as caries is one of the most prevalent diseases worldwide. Dental pulp contains stem cells capable of regenerating the dentine in the tooth, consequently, healthy dental pulp is essential for long term tooth survival. The aim of this study was to incorporate a variety of polymers that provide strength, an antibacterial substance and a protein-based polymer to provide cell support. These components were combined into a triphasic hybrid dental biocomposite (3HB), that together could provide regenerative properties for the pulp tissue. The 3HB biocomposite was incorporated into Organic–inorganic nanostructured materials such as Mineral Trioxide Aggregate (MTA) as a base to assemble a hybrid dental biocomposite. The effects of the 3HB on cytotoxicity was examined in mouse dental pulp cells, MDPC-23. In vitro studies showed that 3HB supported the proliferative growth of the cells significantly more than the no treatment control. 3HB also caused little stress to the cells and supported cell viability. Fourier transform infrared (FTIR) spectra confirmed the presence of polymer functional groups within the 3HB biocomposite. Therefore, 3HB compound has the potential to be applied as a pulp wound dressing providing superior cytocompatibility than the present options but also may be indispensable for the regeneration of dental pulp.

On the vital role of enamel prism interfaces and graded properties in human tooth survival

Teeth of omnivores face a formidable evolutionary challenge: how to protect against fracture and abrasive wear caused by the wide variety of foods they process. It is hypothesized that this challenge is met in part by adaptations in enamel microstructure. The low-crowned teeth of humans and some other omnivorous mammals exhibit multiple fissures running longitudinally along the outer enamel walls, yet remain intact. It is proposed that inter-prism weakness and enamel property gradation act together to avert entry of these fissures into vulnerable inner tooth regions and, at the same time, confer wear resistance at the occlusal surface. A simple indentation experiment is employed to quantify crack paths and energetics in human enamel, and an extended-finite-element model to evaluate longitudinal crack growth histories. Consideration is given as to how tooth microstructure may have played a vital role in human evolution, and, by extension, to other omnivorous mammals.